# CENTRAL CALIFORNIA CHEST SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073065512
- **Authorized official:** MRS. GLORIA SUPERNAW (BILLING AND CONTRACTING MANAGER)
- **Authorized official phone:** (559) 935-5491

## Contact information

- **Practice address:** 729 N MEDICAL CENTER DR W STE 223, CLOVIS, CA 93611-6885
- **Practice address phone:** (559) 449-9990
- **Practice address fax:** (559) 449-9991
- **Mailing address:** 729 N MEDICAL CENTER DR W STE 223, CLOVIS, CA 93611-6885
- **Mailing address phone:** (559) 449-9990
- **Mailing address fax:** (559) 449-9991

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | A99566 | CA | Yes |

## Other

- **Enumeration date:** 11/01/2016
- **Last updated:** 02/04/2020